Suicidality in PTSD

In DSM-5 suicidality is not diagnostic criterion for PTSD, however, in clinical practice working with severely traumatized patient this problem is quite common

Severe psychological trauma (complex trauma) often impacts all aspects of the self-structure – one’s image of the body; the internalized images of others; and one’s values and ideals – and leads to a sense that self coherence and the self’s goals are invaded, assaulted and systematically broken down

Due to the timeless and unintegrated nature of the traumatic memories, trauma victims remain embedded in the trauma as a contemporary experience, instead of being able to accept it is secondary and belongs to the past

The meaning of the traumatic past evolves over time, and often includes feelings or irretrievable loss, anger, betrayal, and hopelessness

Clinicians treating severe traumatized individuals should be aware that suicidality may constitute one of the most important clinical symptoms cluster to evaluate

Suicidality in MDD

Research has shown that more than 90% of people who kill themselves have depression or another diagnosable mental or substance abuse disorder

Depression is the cause of over two-thirds of the reported suicides in the U.S. each year

The intent of this measure is for a clinician to assess suicide risk at initial intake or at the visit in which depression was diagnosed

As the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (eg, psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse, history and seriousness of previous attempts, particularly, recent suicidal behavior, current stressors and potential protective factors (eg, positive reasons for living, strong social support), family history of suicide or mental illness or recent exposure to suicide, impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions, and putting one's affairs in order (eg, giving away possessions, writing a will)

Suicide risk should be monitored especially for the 90 days following the initial visit and throughout MDD treatment